Patient Safety

SS 34 - Patient Safety

245 - Analysis of Retrospective Versus Prospective Peer Review in a Multisite Academic Radiation Department

Wednesday, October 24
7:45 AM - 7:55 AM
Location: Room 008

Analysis of Retrospective Versus Prospective Peer Review in a Multisite Academic Radiation Department
K. Shiue1, N. Agrawal1, J. A. Holmes1, R. M. Rhome2, G. Bartlett1, C. DesRosiers1, K. M. Hutchins1, and G. Watson1; 1Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, 2Indiana University Radiation Oncology, Indianapolis, IN

Purpose/Objective(s): Our multisite academic radiation department transitioned from weekly retrospective to daily prospective peer review to improve plan quality and decrease the rate of plan revisions after treatment start. We review our initial experience regarding deviation patterns and time from simulation to treatment start.

Materials/Methods: In all, 798 patients with 1124 plans were reviewed: 611 plans weekly from 7/12 to 10/18/17 and 513 plans daily from 10/16/17 to 1/12/18. In the weekly era, plan review primarily occurred after treatment start (5.6% prospectively reviewed) and was based on screenshots of beam arrangement, dose distribution, and dose-volume histograms. In the daily era, plan review was performed in a treatment planning system with emphasis on prospective timing of review (75.4% prospectively reviewed). Brachytherapy, Gamma Knife, and most emergent plans were not reviewed prospectively. Plans were assessed for appropriateness of treatment intent, dose-fractionation, simulation, modality, contours, target coverage, and risk to critical structures. Deviations were major if plan revisions were recommended prior to the next fraction and minor if modifications were suggested but not required for that course. All physicians and representatives from dosimetry and physics were required to attend. Categorical variables were compared using chi-squared tests of independence; means were compared using independent t-tests.

Results: Overall, 76 (6.8%; 31 major) deviations were noted. Rates of any deviation were increased in the daily era (8.6% vs 5.2%, p = 0.031) and with prospective review (9.7% vs 5.0%, p = 0.003), with higher rates of major deviations in the daily era (4.1% vs 1.6%, p = 0.016 major; p = 0.542 minor) and with prospective review (5.0% vs 1.4%, p = 0.001 major; p = 0.347 minor). In the subset of plans excluding brachytherapy, Gamma Knife, and boosts not specifically resimulated (N = 844), mean working days between simulation and treatment was similar across eras (5.55 days vs 5.53 days, p = 0.923) but was increased with prospective review (6.04 days vs 5.22 days, p = 0.001). Deviations (N = 76) were addressed at a higher rate in the daily era (84.1% vs 31.3%, p < 0.001) and with prospective review (85.4% vs 34.3%, p < 0.001). The rate of plan revisions after treatment start due to peer review was not related to era (11.4% vs 25.0%, p = 0.136) but was decreased with prospective review (7.3% vs 28.6%, p = 0.030). The rate of plan revision recommendations not followed was numerically decreased in the daily era (4.5% vs 15.6%, p = 0.100) and with prospective review (4.9% vs 14.3%, p = 0.154).

Conclusion: Daily peer review with emphasis on prospective plan evaluation was related to increased rates of deviations recorded and corrected without a prolonged interval between simulation and treatment. Daily prospective plan review is feasible in a multisite academic setting and is an integral part of our process improvement strategy for excellence in patient care.

Author Disclosure: K. Shiue: None. N. Agrawal: None. J.A. Holmes: None. C. DesRosiers: None. G. Watson: None.

Kevin Shiue, MD

Disclosure:
No relationships to disclose.

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